Metacognitive Therapy in Recurrent and Persistent Depression: A Multiple-Baseline Study of a New Treatment

Abstract

Metacognitive Therapy (MCT) for depression is a formulation-driven treatment grounded in the Wells and Matthews (Attention and emotion: A clinical perspective, 1994) self-regulatory model. Unlike traditional CBT it does not focus on challenging the content of depressive thoughts or on increasing mastery and pleasure. Instead it focuses on reducing unhelpful cognitive processes and facilitates metacognitive modes of processing. MCT enables patients to interrupt rumination, reduce unhelpful self-monitoring tendencies, and establish more adaptive styles of responding to thoughts and feelings. An important component of treatment is modification of positive and negative metacognitive beliefs about rumination. MCT was evaluated in 6-8 sessions of up to 1 h each across 4 patients with recurrent and/or chronic major depressive disorder. A non-concurrent multiple-baseline with follow-up at 3 and 6 months was used. Patients were randomly allocated to different length baselines and outcomes were assessed via self-report and assessor ratings. Treatment was associated with large and clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and gains were maintained over follow-up. The small number of cases limits generalisability but continued evaluation of this new brief treatment is clearly indicated.

Repetitive negative thinking predicts depression and anxiety symptom improvement during brief cognitive behavioral therapy

“…Of those available are rumination-focused cognitive behavioral therapy (RFCBT; Watkins et al, 2007Watkins et al, , 2011, concreteness training (Watkins et al, 2012), metacognitive therapy of depressive rumination (Wells et al, 2009), and cognitive behavioral group therapy for depressive rumination ( (Teismann et al, 2014). A recent study integrated components from both RFCBT and metacognitive therapy (e.g., attention training, restructuring metacognitive beliefs about rumination, mindfulness, acceptance and action) into a single rumination-focused protocol for residual depression (Teismann et al, 2014).…”

Positive and Negative Beliefs About Depressive Rumination: A Psychometric Evaluation of Two Self-Report Scales and a Test of a Clinical Metacognitive Model of Rumination and Depression

“…In a case series, attention training was associated with clinically significant decrements in depression, metacognitions, and rumination in patients with recurrent major depressive disorder and these changes were maintained at 12 months follow-up (Papageorgiou and Wells 2000). A recent study examining metacognitive therapy for depression showed large and clinically significant improvements in depressive symptoms, rumination, and metacognitive beliefs and gains were maintained over follow-up (Wells et al 2009). Thus, metacognitive-focused therapy might be a promising treatment for depression but should be compared to standard cognitive therapy in future research.…”

Les thérapies basées sur l’acceptation et la pleine conscience

“…« je ne peux rien faire face à mes pensées ») au sujet des ruminations. Elle a été étudiée pour le traitement de l'anxiété généralisée et la dépression (Wells et al, 2009 ;2010 ; La thérapie cognitive basée sur la pleine conscience (TCBPC) La TCBPC (Segal, Williams et Teasdale, 2002) est une approche inté-grative combinant une approche visant une réduction du stress par la pleine conscience dans un milieu médical (la MBSR, mindfulness based stress reduction de Jon Kabat Zinn, 1982 ; 1990) et la thérapie cognitivo-comportementale de la dépression (Beck, Rush, Shaw et Emery, 1976). Cette thérapie vise à diminuer les rechutes dépressives chez les patients actuellement en rémission d'un épisode dépressif majeur.…”